Hi David, Suggest you look at the creating systems for Patient-centered and controlled Healthcare Records that incorporate portions of the Practitioner created and maintained Healthcare Records.
Regulations and other 'governance' was designed primarily to target Practitioners and the practice of Medicine. In many cases they are protective. Much like the 'common law' of ancestral England where the intent was to keep the populated well enough for battle. Modern regulations, e.g., Patient privacy, are designed to keep noses out of the Patient's and their Practitioner's business, e.g., Insurance Companies. However, Patient controlled secure Healthcare Record Systems are apparently different under the law, exception for the companies controlling them, so that, with secure coverage for all transactions, the Patient and Practitioner can maintain their relationship in private. Even other Healthcare service providers (e.g., labs) would deal with Patient-Practitioner provided identification objects. There seems to be low impact upon the Practitioner while the Patient has to take some additional control over the management of their Healthcare (e.g., responsible for maintaining the records). As a Patient Advocate I have been looking at the Patient's side of the equation and it is not as bleak as one might think. Even Senior Citizens are becoming computer literate and computer application trainable. The younger generations are already there. Could be interesting for 'Down Under' and Remote Medicine in general. Regards! -Thomas Clark Bigpond wrote: >International Law now there's a fascinating issue. We can't even get >Australian law to work across 7 states and territories. We have a good >chance with HealthConnect and a strong central drive (but....). Goodness >knows how the USA will achieve it. We are all watching the UK NHS experience >with interest. I remember when we were looking at telehealth services across >state boundaries and the legal minefield of registration and accreditation >let alone litigation. >What interesting times we can observe! > >As always it will not be the technical issues that stop (slow) us - mind you >archetypes are a challenge (sorry Sam) and so is the HL7 RIM! > >In any event it will be the human factors that get us in the end - consumer >rights, privacy, professional roles, security, data aggregation and simple >fear and stubbornness. > >At the end of the day what created the medical record and why? Have we lost >sight of its use as a simple and effective knowledge management tool for >individual clinicians to work in the way that they wanted too -flexible to >cope with all their individuality and frailties. This will be the stumbling >block as we try, oh so hard to make it a holy grail of health care - it >never was and I doubt it ever will be. > >Hey but isn't it fun! > >David from Downunder. > >-----Original Message----- >From: owner-openehr-technical at openehr.org >[mailto:owner-openehr-technical at openehr.org] On Behalf Of Bob Smith >Sent: Saturday, 5 March 2005 11:33 PM >To: openehr-technical at openehr.org >Subject: RE: Governance and Legal Demographics services? > > >Hello David and Thomas, > > >You said: > > > >>>You speak much sense!! >>> >>> > > > >>>"The Legal environment in particular requires reconstruction." >>> >>> > >When you combine these ideas of "Sense Making" and "Reconstructing the legal >environment's relationships to medical communities of _EHR practice" we >tickle the need for some common upper ontology for the domains of governance >which includes the process by which the legal environments are created and >maintained in various countries. > >Several of us involved in a US NHIN_EHR Request for Information process have >begun muddling the question of governance in standards bodies such as OASIS >and considering the processes by which XML evolved under Jon Bosak and >others a decade ago as the basis for building some US Natl Health >Info/Knowledge Networks to support standards for _EHR deployment and use. > >So an intenational awareness is essential, but how far has the openEHR >community explored these dynamic issues? And how are the relationships being >expressed? > >Bob > > > >-----Original Message----- >From: owner-openehr-technical at openehr.org >[mailto:owner-openehr-technical at openehr.org] On Behalf Of Bigpond >Sent: Saturday, March 05, 2005 4:25 AM >To: openehr-technical at openehr.org >Subject: RE: Demographics service > >You speak much sense!! > >"The Legal environment in particular requires reconstruction." > >Oh that was the best one I heard today - it's in the order of when the warp >drive emerges. > >Need to think more on your wise thoughts though. > >David >-----Original Message----- >From: owner-openehr-technical at openehr.org >[mailto:owner-openehr-technical at openehr.org] On Behalf Of >lakewood at copper.net >Sent: Saturday, 5 March 2005 3:36 AM >To: openehr-technical at openehr.org >Subject: Re: Demographics service > >Hi David, > >Significant problem! However, software configuration management has >solved this >before. In the Legal or secure OS environments the contributions of >individuals are >in fact part of the record even through the 'end-game' is an update that >merges the >contributions of all, e.g., a composite record. > >It is critical that 'information' is not lost nor corrupted. Efforts to >'crunch' multiple >records into a satisfactory record usually fail this requirement at some >point. > >A reasonable objective is to permit multiple Practitioners to enter >information >simultaneously, maintain original context and content, build a composite >record >that is compatible with the target record-handling system, and support 100% >re-assembly of all sources of information. A 'build-and-submit' or >'interactive-entry' >architecture can yield multiple 'composite' records that may also be >linked by one >or more events, e.g., surgery and lab work. > >It may also be necessary to declare a higher-order event (in a record) >to which >subsequent events can be linked (extra-record, meaning the event can >transcend >a collection of records, e.g., multiple contacts-same cause). > >Information organization is a virtue; lack of it may well impact >information retrieval. > >Try coordinating the activities and results of 20+ Software Engineers >working on a >release. Things happen in parallel. The Legal environment in particular >requires >reconstruction. > >Regards! > >-Thomas Clark > > >Bigpond wrote: > > > >>The EHR is rather a unique document and a layered approach is necessary as >>old data must never be altered - may not necessarily be accessible but must >>never be altered. Errors can be corrected but the error must remain totally >>accessible in the manner it was presented to the clinician when it was >>relied upon - eg clinical results, medications. >>The concept of layering new information on old is important. >>There does have to be lock outs or transaction controls when new data is >>being entered in but there is no need for old material (old may be seconds >>of course)to be locked out cause it can't or shouldn't be changed. >>If two doctors are entering elements of say a discharge summary then one >>cannot edit while another is adding - it needs a message indicating someone >>else is working on the current document and wait. It is more complex than >>that but the basic principle applies old data never changes even old >>addresses must stay. >>Legally it is important to be able to reproduce exactly the circumstances >>that the computer presented to the clinician at any point in time for >>inquests, litigation etc. >>We are dealing with these issues today with our CIS and it is a challenge. >> >>David Evans >>Brisbane Australia >> >> >> >>- >>If you have any questions about using this list, >>please send a message to d.lloyd at openehr.org >> >> >> >> >> >- >If you have any questions about using this list, >please send a message to d.lloyd at openehr.org > > >- >If you have any questions about using this list, >please send a message to d.lloyd at openehr.org > > >- >If you have any questions about using this list, >please send a message to d.lloyd at openehr.org > > >- >If you have any questions about using this list, >please send a message to d.lloyd at openehr.org > > > - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
